ELEMENTS OF THERAPEUTIC 2.

Social distance (about 4-12 ft away from body)

RELATIONSHIP • Conversation with strangers

• The distance is acceptable for communication in
GOAL- helping the client for the growth and learning, social, work and business settings
directed and purposeful, there is boundary
3. Personal distance (18-36 inches)
ROLE and RESPONSIBILITY- must be clearly
defined • This distance is comfortable between family and
friends who are talking
CONFIDENTIALITY- appraise the patient with all the
information gathered 4. Public distance (12-25 ft)

THERAPEUTIC BEHAVIOR- aware of thoughts and • This is acceptable distance between a speaker and
feelings, values clarification an audience, small groups and other informal
functions
STAGES

• Pre-orientation
• Orientation Touch
• Working • Very powerful communication tool
• Termination • Can either be positive or negative reaction
depends upon the people who’s rendering

THERAPEUTIC COMMUNICATION 5 types of Touch

Therapeutic Communication 1. Functional-Professional – used in exams or

procedures
Interpersonal interaction between the nurse and client 2. Social-Polite – used in greeting (handshake, air
during which the nurse focuses on the client’s needs to kisses some women use to greet acquaintances,
promote an effective exchange of info gentle hand guides someone in the correct
Process in which the nurse consciously uses the verbal direction)
and non-verbal in the goal of helping the client 3. Friendship-Warmth – hug in greeting, arm
thrown around the shoulder of a good friend, back
Non verbal slapping some men use to greet friends and
relatives
Non verbal- gestures, facial expression
4. Love-intimacy – tight hug and kisses between
KINETICS- body movement, facial expression lovers or close relatives
5. Sexual-Arousal – used by lovers
PROXEMICS- distance or space between

ACTIVE LISTENING
Four Distance Zones
• Means refraining from other internal mental
1. Intimate distance (0-18 inches between people) activities and concentrating exclusively on what
• Close distance that individuals will allow client says
between themselves and others ACTIVE OBSERVATION
• Close conversation with friends and colleagues,
parents with young children, people who • Means watching the speaker’s non verbal actions
mutually desire body contact as he/ she communicates
 Encouraging expression- asking the client to appraise
the quality of his or her experiences “What are your
SOCIAL and THERAPEUTIC Relationship
feelings in regard to…?” “Does this contribute to your
distress?”
Differentiation SOCIAL THERAPEUTIC
INTERACTION RELATIONSHIP Exploring- delving further into a subject. “Tell me more
about that”
Characteristics Personal and Personal but NOT
Focusing- concentrating on a single point. “This point
intimate intimate
seems worth looking at more closely”

Goal Doing favor for Promoting Formulating a plan of action- asking the client to
mutual benifit functional use of consider kinds of behavior likely to be appropriate in
one’s latent inner future situations. “What could you do to let your anger out
resources harmlessly?”
General leads- giving encouragement to continue “Go
Termination Not defined Defined in the on” “And then?”
beginning
Giving information- making available the facts that the
Identification May not occur By the client with client needs. “My name is…” “Visiting hour are…”
of needs the help of the Giving recognition- acknowledging, indicating
nurse awareness. “Good morning, Mr. …”

Resource used Variety during Specialized Making observations- verbalizing what the nurse
interaction professional skills perceives. “You appear tense”
for intervention Offering self- making oneself available “I’ll sit with you
awhile”
Placing event in time or sequence- clarifying the
THERAPEUTIC COMMUNICATION relationship of events in time. “What seemed to lead up
Therapeutic Communication Techniques to…?

Technique Presenting reality- offering for consideration that which

is real. “I see no one else in the room”
Reflecting- directing client actions, thoughts and feelings
Accepting – indicating reception “Yes”; “I follow what back to client
you said”
Client: Do you think I should tell the doctor?
Broad openings – allowing the client to take the initiative
in introducing the topic. “Is there something you’d like to Nurse: Do you think you should?
talk about?” “Where would you like to begin?” Restating- repeating the main idea expressed. Client: I
Consensual validation- searching for mutual can’t sleep Nurse: You have difficulty sleeping
understanding, for accord in the meaning of the word. Seeking information- seeking to make clear that which
“Tell me whether my understanding of it agrees with is not meaningful or that which is vague. “I’m not sure
yours.” that I follow”
Encouraging comparison- asking that similarities & Silence- absence of verbal communication, which
differences be noted. “Was it something like…?”” Have provides time for the client to put thoughts or feelings into
you had similar experiences?” words
Encouraging description of perceptions- asking the Nurse says nothing but continues to maintain eye contact
client to verbalize what he or she perceives. “Tell me and conveys interest
when you feel anxious” ”What is happening?”
Suggesting collaboration- offering to share, to strive, to Giving literal responses- responding to a figurative
work with the client for his or her benefit. “Perhaps you comment as though it were a statement of fact.
and I can discuss and discover the triggers for your
Client: They’re looking in my head with a television
anxiety”
camera
Summarizing- organizing & summing up that which has
Nurse: Try not to watch TV
gone before “Have I got this straight?”
Indicating the existence of an external source-
Translating into feelings- seeking to verbalize client’s
attributing the source of thoughts, feelings, and behavior
feelings that he or she expressed only indirectly.
to others or to outside influences
Client: I’m dead
“What makes you say that?”
Nurse: Are you suggesting that you feel lifeless?
Interpreting- asking to make conscious that which is
Verbalizing the implied- voicing what the client has unconscious. “What you really mean is…?
suggested.
Introducing an unrelated topic- changing the subject.
Client: I can’t talk to you or anyone. It waste my time Client: I’d like to die
Nurse: Do you feel that no one understands? Nurse: Did you have visitors last evening?
Voicing doubts- expressing uncertainty about the reality Making stereotyped comments- offering meaningless
of the client’s perceptions clichés. “Its for your own good”
“Isn’t that unusual?” Probing- persistent questioning of the client. Now tell me
about this problem. You know I have to find out”
Reassuring- indicating there is no reason for anxiety. “I
Non therapeutic Comm. wouldn’t worry about that”
Advising- telling the client what to do. “I think you Rejecting- refusing to show contempt for the client’s
should…” ideas. “Let’ s not discuss…”
Agreeing- indicating accord with the client. “That’s Requesting an explanation- asking the client to provide
right..” reasons for thoughts, feelings, behaviors, events. “Why
Belittling feelings expressed- misjudging the degree of do you think that?”
the client’s discomfort. Testing- appraising the client’s degree of insight. “Do you
Client: I have nothing to live for… I wish I was dead” know what kind of hospital this is?

Nurse: Everybody gets down in the dumps” Using denial- refusing to admit a problem exists

Challenging- demanding proof from the client Client: I’ m nothing

“But how can you be president of the United States?” Nurse: Of course your something- everybody’ s
something
Defending- attempting to protect someone or something
from verbal attacks. “This hospital has a fine reputation”
Disagreeing- opposing the client’s ideas. “That’s wrong”
Disapproving- denouncing the client’s behavior or ideas.
“That’s bad”
Giving approval- sanctioning the client’s behavior or
ideas. “That’s good”
Defense Mechanisms
Anna Freud
Defense mechanisms are methods or coping strategies of
attempting to alleviate anxiety, to protect the self with the
basic drives or emotionally painful thoughts, feelings or
events.
Anna Freud - defense mechanism evolve during
specified developmental stage and are more likely to
result in maladaptive behaviors when are used too early
and too long
GENERAL ASSESSMENT  DSM–5 is the standard classification of mental
disorders used by mental health professionals
Assessment
 DSM-5-TR will be published in March 2022
A. Systematic Data Collection
Planning
1. Effective Interviewing
• once nursing diagnosis are identified, it is important
• Nursing history is an essential tool in developing to establish priorities. Maslow’s hierarchy of needs is
the assessment data base. a good way of establishing care priorities.
• It is from this information that the care plan is • goals are established to guide the planning phase.
developed. Include the client and establish mutually acceptable
• Basic nursing history tool in mental health goals are important to nursing care outcomes.
nursing includes functional health patterns and • objectives or expected outcomes are necessary to
socio cultural needs. spell out the behaviors the nurse will observe the in
the client to indicate that goals have been achieved.
2. Observations of objective and subjective behaviors
A. Development of nursing care plan
• Mental health nurse uses observation, interview,
the nurse-client relationship, therapeutic 1. Specific client goals based on client needs
communication techniques, mental health status
2. Interventions unique to client needs
examination, other tests and the medical
diagnosis to assist in formulating nursing
diagnosis.
B. Guide to therapeutic interventions
B. Recording Data
C. Collaboration with others
C. Data review of documents available in the practice
setting (chart, medical history, laboratory results etc.) Interventions
Basic types:

Nursing Diagnosis 1. Dependent

A. Standard Nursing Diagnosis 2. Independent

3. Interdependent depending on each other
• Marjory Gordon’s definition of nursing diagnosis
– derived from database obtained by nursing
history and other tools available.
• Defining characteristics are observed as data are Primary independent: THERAPEUTIC
collected and assist the mental health nurse to RELATIONSHIP between the nurse and client.
specify the etiology underlying diagnosis Phases: introductory, working and termination
• DSM IV – TR alerts the nurse to potential
defining characteristics within specific mental  Nursing Actions
disorder categories.
✓ to promote, maintain or restore physical and
B. Comparison of standard nursing diagnoses to mental
diagnostic classification of mental disorders
✓ To prevent illness
C. Recognition of actual or potential health problems
✓ To effect rehabilitation
D. Opportunities for validation of diagnosis of peers
✓ Interventions validated by client and peers
in the practice setting
✓ Psychotherapeutic interventions
 Diagnostic and Statistical Manual of Mental
Disorders (DSM–5) ✓ Health-teaching interventions
✓ Activities of daily living interventions
 ✓ Somatic therapy interventions 5.If the client has difficulty maintaining boundaries, the
nurse may use a more formal setting.
✓ Therapeutic environment interventions
6.Ensure the patient’s privacy, including asking the
Evaluation
client who should be present during the interview.
• Purpose: to determine the client’s progress, 7. Choose a quiet, calm, private setting (interruptions
effectiveness of NCP, interventions, and distractions threaten confidentiality and may interfere
determination of goal attainment and provision effective listening). Remove objects in the room that may
of a new data base for changes in the plan of care. distract the patient.
Criteria for evaluation: Formative – on going; 8.Reassure the patient that he’s safe (if necessary).
Summative- terminal
9.Show support and sensitivity.
• Self-evaluation – is an essential art of mental
health nursing because of the nature of the use of 10.Use reliable information sources.
self in independent nursing interventions.
11.Check hospital records from previous admissions, if
A. Recording, communicating and revising possible, when comparing the patient’s past behavior with
the current situation.
B. Evaluate client responses to nursing interventions
12.Listen carefully and objectively to make the patient
1. Revise the data feel comfortable enough to discuss his problems and
2. revise nursing diagnosis responding with sensitivity.

3. revise care plan 13.Avoid taking extensive notes during the interview
(can cut down on the nurse’s ability to listen)
C. Pursue validation, suggestions and new information
14.Use open ended questions to start the assessment
D. Documents results of evaluation (allows the client to begin as he feels comfortable and also
gives the nurse an idea about the client’s perception about
E. Evaluate self-performance on therapeutic
the situation)
interventions
15. If client cannot organize his thoughts or has
difficulty answering open-ended questions, use questions
Principles and Techniques of Mental Health – that are more direct, clear, simple, focused on one
Psychiatric Nursing Interview specific, behavior or symptom to obtain information.

1. Assume an open posture. Sit facing the client with 16. Use non-judgmental language and matter- of- fact
both feet on the floor, knees parallel, hands at the sides of tone particularly when asking about sensitive information
the body, legs not crossed or crossed only at the ankle. 17. Validate non-verbal cues of the client rather than
(this posture demonstrates unconditional positive regard, assume what the client is thinking or feeling.
trusting, caring and acceptance)
18. Maintaining good eye contact is important but the
2.Explain the purpose of the interview, why the nurse must not stare at the client.
information is necessary and help him recognize the
benefits of dealing with problems openly. 19. Allow the client to respond even if it seems like a
long time.
3.Sit beside or cross from the client(can put the client at
ease instead of sitting behind a desk which can decrease 20. When meeting the patient for the first time, introduce
the client’s willingness to open up and communicate self and explain the purpose of the interview. Then ask the
freely) patient how he would like to be addressed.

4.Keep chairs to be used by the nurse and patients of 21. Initial interview generally lasts for 30-60 minutes.
approximately equal in height so that neither person looks Keep interviews with psychotic patients brief because
down on the other they are easily stressed.
22. Find out the patient’s cultural beliefs.
23. When possible, note specific details to fully explore Categories of information in MSE
the patient’s chief complaints.
1. General behavior, appearance and attitude
24. If the patient is capable of holding an in-depth
2. Characteristic of talk
conversation, obtain a detailed personality profile.
3. Emotional state
25. Explore previous psychiatric or psychological
disturbances the patient may have had and previous 4. Content of thought
treatment he may have received.
5. Orientation
26. Obtain a detailed psychosocial history
6. Memory
27. Obtained a detailed family history
7. General intellectual level
28. Review the patient’s medical history.
8. Abstract thinking
9. Insight evaluation
MENTAL STATUS EXAMINATION
10. Summary
History

• Background assessment include the client’s

history Nursing Responsibilities
• Chronologic and developmental age • Inform the patient or accompanying family members
• Developmental stage that the test usually takes 30-90 minutes. It may take
• Cultural considerations- many cultures have longer if more extensive tests are to be performed. Ex.
beliefs and values about a person’s role in the Welchsler Adult Intelligence
society or acceptable social or personal behavior • Scale takes several hours to complete
that may differ from those of the nurse • If the test includes assessment of behavioral
Spiritual beliefs problems, the examiner will try to reveal the patient’s
feelings a emotions
Previous history – has the client experienced similar • It is important to build rapport with the patient to gain
difficulties in the past trust and cooperation during the test
• The nurse should take note of any physical disabilities
➢ PRIMARY PURPOSE: to help the examiner
that the patient has that could interfere with Body
gather more objective data to be used in
stiffness and rigidity because limbs are drawn up
determining etiology, diagnosis, prognosis and
tightly against his body (fetal position). If you
treatment and to deal immediately with any risk
attempt to touch the body, tension is increased leading
for violence or harm.
to the test to be given.
Also: identifies the person’s present mental status
Sensorium and intellect are particularly important
A. General behavior, appearance and attitude
in determining the existence of delirium, dementia,
amnestic and other cognitive disorders. Complete and accurate description of client’s physical
characteristics, apparent age, manner of dress, use of
cosmetics, personal hygiene and responses to the
examiner
• Includes posture, gait, facial expression and
mannerisms
• Client’s general activity level
❑ Automatisms – repeated purposeless behaviors
often indicative of anxiety (drumming of fingers,
twisting locks of hair, tapping the foot)
❑ Psychomotor retardation- overall slowed ❑ Ticks and spasms - uncontrollable jerking and
movements twitching of some part of the body usually in the
head, face and neck
❑ Waxy flexibility – also called cerea flexibilitas
• psychogenic related to unconscious
• maintenance of posture or position overtime
conflict; appears to be organic in etiology
when in awkward or uncomfortable;
but maybe of psychic in origin
extremities maybe molded into any position,
• occur in front of unfamiliar person
in paused posture in prolonged period for 12
because of increased consciousness;
hour
anxiety is displaced through actions such
• patient feels insensitive to fatigue,
as eye blinking
exhaustion, distress or discomfort
• common among catatonic schizophrenic
stupor state
B. Characteristics of Talk
✓ The form rather than the content of client’s
❑ Pathologic limb rigidity – in catatonic
speech, how the client can deliver his/her thought
schizophrenic stupor stage.
✓ The SPEECH is described in terms of loudness,
• body stiffness and rigidity because limbs are
flow, speed, quantity, level of coherence and logic
drawn up tightly against his body (fetal),
when you attempt to touch the body, there ✓ The goal is to describe the quality and quantity of
will be increase in tension and there will be speech to discern difficulties in thought process
resistance.
❑ Circumstantiality - cumbersome, convoluted
• It signifies negativistic response or regression
and unnecessary detail in response to the
to infantile level of need, communication or
interviewer’s questions.
disease
• May symbolize withdrawal from emotionally • caused by beating around the bush (pt.
painful reality with an associated need for with severe anxiety)
communication
❑ Perseveration - a pattern of repeating the same
❑ Echopraxia – involuntary imitation another words or movements despite apparent efforts to
person’s gestures, body movement, repeated or make a new response
duplicated movement of others as if compelled to
do so; different from “mimic” bec. there’s no ❑ Mutism - no verbal response despite indications
humor; common in schizophrenia that the client is aware of the examiner’s
questions
• Maybe a security achieving operation
which is stronger than one’s conscious ❑ Flight of ideas – rapid, overly productive
control responses to questions that seem related only by
chance associated between one sentence
❑ Compulsions - repetitive acts performed through fragment and another. Associated with flight of
some inner need or drive and supposedly against ideas might be rhyming, clang associations,
the client’s wishes yet not performing them punning and evidence of distractibility (bipolar)
results in tension and anxiety
• excessive amount and rate of speech
• motivated by unconscious isolations of composed of fragmented or unrelated
earlier emotional traumatic experiences ideas.
❑ Impulsiveness - sudden outburst of physical ❑ Clang association – words with similar sounds
activity without forethought or conscious that are linked by patients; used by manic patients
judgment to conceal communication impairment.
• unpredictable, unexpected; outcome of
long period of mental unrest
 ❑ Punning – injection by patient of witty or clever o The relationship between mood and the
remarks into conversation to gain attention, content of thought is particularly
recognition, feeling of acceptance and increase significant
self-esteem; used by manic patients
o Clients who are trying to cover up a deep
❑ Rhyming – rhyming of phrases or whole
depression may show cheerfulness and
sentences in lyrical or poetic which is used in
good spirits
conversation.
There may be a wide divergence between what
❑ Echolalia – repetition of immediate speech of
the clients say or do and their emotional state as expressed
another as if experiencing a compulsion to
by attitudes or facial expressions.
respond. It maybe a security operation or the
pathological suppression of data which is painful • Shallowness or flattening of affect – an
to verbalize. insufficiently intense emotional display in
association with ideas or situations that ordinarily
❑ Blocking – a pattern of sudden silence in the
would call for a stronger response; showing no
stream of conversation for no obvious reason but
facial expression
often thought to be associated with intrusion of
delusional thoughts or hallucinations. • Inappropriate affect- displaying a facial
expression that is incongruent with mood or
❑ Word salad – flow of unconnected words that
situation; often silly or giddy regardless of
convey no meaning to the listener
circumstances
❑ Neologisms – new words coined by patient
• Blunted affect – showing little or slow to
respond facial expression; a flattening of affect or
loss of capacity to experience and express
C. Emotional State or Mood emotional at normal intensity. It may progress to
✓ refers to the person’s pervasive or dominant loss of feeling of sympathy toward a relative and
mood or affective reaction both subjective to loss of such primitive emotions of fear, rage
and objective. and sexual drive

Affect – the outward expression of the client’s emotional • Apathy – a reduction or dulling of emotional
state. response to stimuli so that one reacts with less
interest, attention and feeling than normally.
✓ Subjective data are obtained through the use Emotionless
of non-leading questions (how are you
feeling?). If the client replies with general • Restricted affect – displaying one type of
terms the interviewer should ask the client to expression, usually somber or serious
describe what he feels. • Broad affect – displaying a full range of
emotional expressions
✓ Observe objective signs such as facial
expression, motor behavior, presence of • Labile – when client exhibits unpredictable and
tears, flushing, sweating, tachycardia rapid mood swings from depressed and crying to
tremors, respiratory irregularities, state of euphoria with no apparent stimuli
excitement, fear and depression
• Ambivalence – the coexistence of two opposing
drives, desires, feelings or emotions

✓ The attitude of the client towards the examiner,

such as hostility, suspiciousness or
flirtatiousness, a desire for bodily contact or
outspoken criticisms, sometimes offers valuable
clues.
o Record verbatim the replies to questions
concerning the client’s mood.
D. Content of thought: special preoccupations ❑ Hallucinations- false sensory impressions with
no external basis in fact; special senses
Thought process - refers to how the client thinks
manifested, produced by internal or subjective
Thought content – what the client actually says experience or sensory perception that does not
result from real external stimulus.
✓ The nurse can elicit these data by asking
questions such as, “do you have any difficulties?” ❖ Types:
“Have you been troubled or ill lately?”
1. Visual
✓ When the nurse encounters clients with marked
2. Auditory
difficulties in thought process and content, ask
focused questions requiring short answers. 3.gustatory
❑ Delusions – false belief that is defended intensely 4. Olfactory
despite its being illogical or unrealistic; a fixed
5. Tactile
false idea not based on reality
❑ Illusions – misinterpretation of an external
❖ Types:
sensory stimulus usually visual or auditory
1. Nihilistic- more or less completely denies reality and
❑ Ideas of reference – client’s inaccurate
existence
interpretation that general events are personally
2. Delusion of self-deprecation – client describes feeling directed to him, such as hearing a speech on the
of unworthy, sinful, ugly or foul smelling news and believing they had personal meaning
3. Delusion of grandeur – associated with elated states ❑ Loose associations – disorganized thinking that
such as great wealth, strength, power, sexual potency or jumps from one idea to another with little or no
identifications with famous persons or even God. evident relationship between thoughts.
4. Delusion of persecution – belief that is being ❑ Obsessions – insistent thoughts recognized as
persecuted arising from the self
5. Somatic delusion- feelings that their body is affected • Involuntary preoccupation with a
with cancer, leprosy, obstructed bowel or some horrible thought or idea that seems irrational
disease. • Client usually regards them as absurd
and relatively meaningless, yet they
❑ Thought broadcasting – a delusional belief that
persist despite endeavors to get rid of
others can hear or know what the client is
them.
thinking
❑ Fantasies and daydreams – preoccupations that
❑ Thought insertion – delusional belief that others
are often difficult to elicit from the client because
are putting ideas or thoughts into the client’s
often people are ashamed to talk about them
head- that is, the ideas are not those of the client.
because of their content
❑ Thought withdrawal – delusional belief that
❑ Tangential thinking (tangentiality) –
others are taking the client’s thoughts away and
wandering off the topic and never providing the
the client is powerless to stop it.
information requested
E. Sensorium and Intellectual process Reasoning and judgement – ask the client what he will
do with a gift of $ 1000
Orientation – refers to client’s recognition of person,
place and time that is knowing who and when. Judgement- refers to the ability to interpret one’s
environment, situation correctly and to adapts one’s
• also, in terms of time, place and self to determine behavior and decisions accordingly
the presence of confusion or clouding of
consciousness;
• many clinicians begin MSE with questions to test
H. Abstract thinking
this.
• Ex. What day is today? ✓ ask the client to interpret simple simple proverbs
/ fables “don’t cry over spilled milk”

F. Memory
I. Insight Evaluation
✓ the person’s attention span and ability to retain or
recall past experiences in both the recent and the Insight – ability to understand the true nature of one’s
most remote past situation and accept some personal responsibility for the
✓ if memory loss exists, determine whether it is situation
constant or variable and whether the loss is
limited to a certain period of time. • ask the client to describe realistically the strength
and weaknesses of his behavior
✓ recall of remote past experiences – ask review • ask if the client recognize the significance of the
of important events in the client’s life present situation, whether they feel the need for
treatment and how they explain the treatment.
✓ recall of recent past experiences – events • ask client for suggestions for their own treatment
leading to the present seeking of treatment J. Summary

✓ retention and recall of immediate impressions K. Self- Concept – the way one views one-self in terms
– ask the client to repeat a name, an address or a of personal worth and dignity
set of objects immediately and again after 3-5
• ask the client to describe himself and what
minutes; repeat 3-digit number or a complicated
characteristics he likes and what he would change
sentence
L. Roles and Relationships
✓ general grasp or recall - ask the client to read a
story and then repeat the gist with as many details • assess the roles that the client occupies, client’s
as possible satisfaction with those roles and if the client
believes he is fulfilling the roles adequately

❑ Confabulation - invented memories to take place M. Physiologic and self-care considerations

of those the client cannot recall
• emotional problems can greatly affect eating and
sleeping patterns. Determine how these patterns
have changed
G. General Intellectual level – non standardized • ask any major or chronic health problems and if
evaluation of intelligence he takes prescribed or illicit medications
✓ nurse looks for the person’s ability to use factual N. Biologic assessment - the nurse must consider the
knowledge in a comprehensive way possibility that the client’s symptoms may have biologic,
General grasp of information – ask who the particularly neurologic basis.
present president of the Phil., the last 4 presidents. • brain imaging techniques (can detect seizure
Ability to calculate – test of simple activity, evaluate sleep disorder, examine blood
multiplication and addition flowing to the brain, identify cerebral atrophy
etc.)
PSYCHOTHERAPIES Milieu Therapy
Definition -Management of the client’s environment to
Psychotherapy
promote a positive living experience and facilitate
• is a general term for treating mental health recovery
problems by talking with a psychiatrist,
psychologist or other mental health provider.
Narcotherapy
Psychoanalysis
• Is the production of a drowsy, yet not an actual
• by Sigmund Freud
sleep-like sate by means of a sedative drug
• the exploration of the unconscious, chiefly thru
free association
• During this period, the psychiatrist interviews the
3 stages: client about his/her problems

a. Free association
• He attempts to uncover and analyze emotional
• the psychoanalyst encourages the patient to conflicts buried in the unconscious mind and not
discuss anything and everything that comes into accessible to him when the patient converses on
his mind during these sessions the conscious level
b. Second stage Play Therapy
• when the patient realizes that he must do • Used in the treatment of children with
something about his problems, he leans towards maladjustment or behavior disorders
the analyst for guidance, love and help
• the analyst constantly reviews the patient who • The child is given toys and while at play, the
attempts to show that patient to reach emotional psychiatrists observe him and tries to discover the
maturity under the guidance of the analyst causes of child’s conflicts
C. Third stage

• slow weaning of the patient from the analyst • At play, the child often imitates their parents,
• the patient attempts to achieve independence and sisters, brothers, teacher, friends etc.
solve his conflicts an a natural level
• Children reconstruct past experiences in their
play and carry out action which they would like
Hypnotherapy to express in real life but may be fearful because
of the possibility of punishment
• A technique where in the psychiatrist induces a
marked state of relaxation in the patient Family therapy

• When the patient is completely relaxed and in a • Is a technique in which the therapist focuses on
sleep-like state, the psychiatrist begins to carry on the behavior with problems
conversation with him
• In family therapy, the therapist is direct, personal
• He may get the patient to talk about things he and actively involves himself with the family
could not say during direct interview, or he may
strongly suggest the disappearance of symptoms, • He begins by observing and picking of cues from
such as pain or paralysis the interaction as soon as the family enters the
room
Therapeutic Community Staff’s Shift-to-Shift Meeting- endorsement
A simple type of milieu therapy by which the total social Advisory Board Meeting- discussion of the demotion
structure of the treatment unit is involved in the helping and promotion of patient status
process.
Attitude Therapy - Prescribed ways on how to handle
Goal and Objectives mentally ill patients according to the behavior symptoms
they manifest.
• To help the patient develop a sense of self-esteem
and self-respect Type of Attitude Therapy
• To help him learn to trust others.
1. Active Friendliness- withdrawn patient
• To improve his ability to relate to others and with
2. Passive Friendliness- paranoid patient
authority.
3. Kind-firmness- depressed client
• To return him to the community, better prepared 4. Matter-of-Fact- manipulative/demanding
to resume his role in living and working. client/elated
Elements 5. No demand- furious/ in rage

1. People
2. Organized Activities Characteristics of Attitude Therapy
3. Environment
• Consistency- must be used for the patient to
reach the maximum therapeutic value.
Characteristics of Therapeutic Community • All persons who come in contact with the patient
should have a uniform attitude.
✓ Emphasis on social and group interaction • Should be prescribed by the physician and should
✓ Focusing Communication be individualized depending on the individual
✓ Sharing responsibilities with patient needs.
✓ Living and learning abilities
Therapeutic Activities:
Therapeutic Activities
✓ Music appreciation thru arts
✓ Craft and occupation therapy 1. ACTIVITIES OF DAILY LIVING
✓ Newspaper discussion
❖ An activity done by an individual which is
✓ Biblio-therapy
necessary for the promotion of good personal
✓ Activities of daily living
hygiene which can be done with or without
✓ Calisthenics
assistance/ supervision to an individual.
✓ Indoor/Outdoor games
✓ Play therapy Objectives
✓ To promote and improve personal hygiene and
Therapeutic Meetings: grooming.
✓ To promote self-independence.
Circle meeting- highlights of the 24 hours
✓ To encourage participation
Small group- personal problems of patient ✓ Evaluation through return demonstration.
✓ To develop awareness on home management and
Community meeting- problems of patient encountered in community development.
the ward of general interest ✓ To develop interpersonal relationship
Treatment Planning- treatment regimen of a patient
Discharge Planning Conference- discharge plan for
patient
Patient Government Meeting- officers of the patients
discuss issue related to their welfare
2. PLAY THERAPY Objectives
❖ A technique that makes it possible for a patient to ✓ To serve as diagnostic tools
express himself freely. ✓ To uncover emotional traumatic experience
❖ Free play enables the individual a unique ✓ To provide a medium for stimulation of inner
opportunity to discharge strong motion in a feelings through music and art
secure atmosphere.
❖ It is also a form of psychotherapy for regressed
4. BIBLIO-THERAPY
psychotics to an extent of making it impossible to
communicate with the through verbal channels. ❖ Used of literature, film, or feature on creative
❖ A form of therapy that brings fun and a form of writing with group discussion to promote self-
exercise, socialization with others, cooperation, acknowledgement and interaction of thoughts
diverting patient’s attention, promote and feelings
sportsmanship and express feeling and thoughts. ❖ A therapy that enhances patients awareness
regarding an article or material as well as it
Objectives:
increases their level of understanding with the
✓ To help patient interact with other patients in a information and content of such reading materials
slightly competitive but thoroughly enjoyable ❖ It stimulates the inner self by expressing their
level, manner. feelings regarding the given story
✓ The client will be able to express themselves
Objectives:
through acceptance and enjoyable means.
✓ To promote diversion from usual routinary ✓ To stimulate the psychological, sociological and
experienced by the client in favor of a more aesthetic values form books into human
dynamic activities character, personality and behavior
✓ To promote cooperation and sportsmanship ✓ To provide stimulus for the memory to compare
✓ Allow free expression of feelings and thoughts events with their own interpersonal and
intrapsychic experience
✓ To increase level of understanding with the
3. MUSIC AND ART THERAPY
information from the reading materials
❖ Music therapy is the opportunity for socialization
and self-expression and sometimes realization
5. OCCUPATIONAL THERAPY
affected by certain musical activities
❖ Art therapy is the process of letting the patient ❖ Any activity mental or physical and guided to an
express his feelings and thoughts through various individual to recover from a handicap
artistic means particularly sketching and drawing ❖ There is an increasing awareness that process,
❖ One type of therapy with purposeful use music and not the product of the process, is the greatest
and art as a participative or listening experienced importance
in the treatment of the patient to improve and ❖ Manual, recreational and creative technique to
motive their mental and emotional state facilitate personal experiences and increase social
❖ Designed to increase patient perception, responses and self-esteem
concentration, memory retention, conceptual
development, rhythmic behavior, verbal retention Objectives:
and auditory discrimination . ✓ To improve general performance
❖ Used to stimulate thoughts and feelings ✓ To obtain essential skills of living
❖ Designed to increase patient perception, ✓ To increase the sense of accomplishment,
concentration, memory retention, conceptual satisfaction and control over one’s owns life
development, rhythmic behavior, verbal retention ✓ To increase social responses
and auditory discrimination . ✓ To increase self esteem
❖ Used to stimulate thoughts and feelings
6. REMOTIVATION TECHNIQUE Subjects/ Topics Not to be Covered
Definition: 1. Religion
❖ Is a technique of every simple group therapy of 2. Politics
an objective nature used to reach the unwounded
3. Love
areas of the patient's personality and get them
moving in the direction of reality 4. Family problem
Indication: 5. Sex
❖ Can be used in any ward situation, regardless of
the length of time the patient has been
hospitalized, his age, or the reason of his illness, Steps
and sex 1. Climate of Acceptance (5 minutes)
❖ Highly indicated for chronic, regressed, long term
hospitalized client − leader stays at the center, greets each
patient and introduces self.
Objectives:
− if first session, ask patients to introduce
✓ To stimulate patients to think about something
themselves one by one.
and talk about himself
✓ To develop ability to communicate and share idea − makes the patients feel relax or
and experience with others comfortable by commenting about the
✓ To develop feeling of acceptance and recognition weather, and or complementing patients
appearance.
Values to patient: − ask about the day and or date to make
them oriented.
✓ Stimulate the patients to follow and explore the
real world 2. Bridge to Reality (15 minutes)
✓ Gives him reason to value himself and increase
his self respect − ask questions leading to the topic to be
✓ Makes him part of the group discussed.
✓ Physical Set-up/Arrangement
− ask anybody to recite a poem related to
✓ Patients maybe seated in circle or u-shape
the topic.
✓ Requires 10-15 patients take about 45 minutes -1
hour − ask questions that are generalized to
specific in nature.
Subjects to be covered:
− read a poem to the group and then ask the
✓ Geography
patient to read it back to the group.
✓ History
✓ Nature − show the visual aids.
✓ Hobbies
✓ Literature
✓ Industry 3. Sharing the World We Live In (15 minutes)
✓ Sports
✓ science − ask stimulating questions regarding the topic,
leader should try to explore the topic.
− let the group share or talk one at a time about
the topic.
4. Appreciation of the Work of the World (15 minutes) B. On the day of ECT

− make sure that you relate that patient with the ✓ Ask the patient to remove jewelry, hairpins,
topic so he may be able to relate it with himself eyeglasses, and hearing aids, dentures
and/or with his job. ✓ Dress the patient in loose, comfortable clothing
✓ Have the patient empty bladder, administer pre-
− this step is blended with 3 step. treatment medications
Procedures for ECT
5. Climate of Appreciation (5 minutes) ✓ Make patient lie simply, with the back resting on
− ask for a summary about the topic. a pillow to promote hypertension of the spine to
prevent fracture of vertebrae or dislocation
− express appreciation to the patients for coming to ✓ Let the patient bite mouth gag
the session. ✓ Apply electrode jelly on the temple to ensure
complete contact
− inform them what topic to be discussed next ✓ Terminal plugs are inserted into electrodes
session or ask their suggestion. ✓ Two assistant support shoulders and wrist joints
and another one to support the knee
✓ Treatment switch is pressed after adjusting the
Electro Convulsive Therapy (ECT) dosage and the patient goes into ground mal
❖ A treatment in which a grand mal seizure is seizure. The electrical is given with up to 150
artificially induced by passing an electrical volts for 0.5 to 2 seconds
current through electrode applied to one or both ✓ When the convulsion subsides and breathing is
temples. The number of treatments given in a resumed, turn the patient on his side to prevent
series varies according to the patient’s initial swallowing of saliva
problem and therapeutic response as assessed ✓ Ventilation and monitoring continue until the
during the course of treatment. The most common patient is recovered
range for affective disorders is from 6-12 DURING TREATMENT
treatments, whereas as many as 30 may given for
schizophrenia. ECT is usually given three times a − patient suffer grand mal seizure/ tonic-clonic =
week on alternative days, although it can be given usually begins with bilateral jerks of the
more or less frequently extremities/ focal seizure activity.

Indications for use are: Tonic – picture of body rigidity at the start of seizure last
for 10 seconds.
✓ Major depressive illness that has not responded to
antidepressant medication or in-patients unable to Clonic – muscular twitching of the entire body and
tale medication storturous breathing froths at the mouth may become
✓ Bipolar disorder in which the patient has not cyanotic and incontinent - last for 1 minute.
responded to medication
✓ Acutely suicidal patients who have not received
medication long enough to achieve a therapeutic AFTER TREATMENT
effect
- upon awakening patient doesn’t remember the period of
Preparation for ECT treatment.
A. Before the day of ECT help administer a few breaths of oxygen following
treatment.
✓ The patient must complete a thorough physical,
neurological and laboratory examination − patient sleeps for 5 - 10 minutes.
✓ Informed consent is obtained
✓ NPO after midnight − close observation by the nurse is essential until
the patient is fully oriented, steady on his feet and

− able to be out of bed.

Nursing Interventions after ECT
✓ Let patient feel comfortable in bed and let him go
to sleep
✓ Monitor respiratory problem
✓ Inspect for any bleeding of gums or bitten lips
✓ Avoid draft and exposure
✓ Re-orient the patient when he wakes up
✓ Documents all treatments
✓ After the patient is oriented and has rested, let
him have a shower and start his usual activities

POINTS TO BE RECORDED DURING ECT

1. Types of seizure.
2. Time of occurrence.
3. Duration and description of reaction.
4. Behavior, general reactions, attitude and remark
before and after therapy or treatment.
EFFECTS OF ECT
1. Sedative effect for the manic.
2. Stimulating effect for depressed.
3. Produce spasm on the brain.
4. Produce amnesia.
COMPLICATION OF ECT
1. Apnea
2. Fracture
3. Temporary amnesia